Crohn’s disease - A Review of Symptoms and Treatment Brian Nguyen University of California - Irvine Medical Center, Orange, CA

Background Inflammatory bowel disease in large intestine and rectum May occur in any part of GI tract Chronic condition Onset occurs 16-40 yrs old Exact cause unknown Genetic risk factors People who have relative with the disease have risk factor 10x greater than general population. Brother or sister, 30x greater.

Background Autoimmune disorder Immune system attacks normal microbes White blood cells rush lining Chronic inflammation Similar symptoms to ulcerative colitis UC affects superficial layers and colon only CD affects all layers and GI tract

Usually found in ileocecal region (small intestine to large intestine) Ileum to cecum Usually found in ileocecal region (small intestine to large intestine)

Normal colon Colon with Crohn’s disease

Symptoms Periods of flare ups Abdominal pain Diarrhea Fever Weight loss Anal pain

Complications Obstruction of bowel Ulcers in tract Malnutrition Swelling or scar tissue Ulcers in tract Can result in fistulas (30%) Abscess Malnutrition Inadequate intake and absorption

Diagnosis Colonoscopy (70% effective) Radiological studies Blood tests Visualization of colon and terminal ileum Radiological studies Can help see remainder of small intestine Highlights inflammation Blood tests Anemia indication for Crohn’s Inflammation of small intestine can be seen with narrowing of the intestine and prevention of passage of stool and air

Treatment No “cure” – only symptom relief Medication Surgery Cortisteroids or anti-inflammatory agents Immunosuppressive drugs Surgery Remove diseased portion of intestine Anastomosis connects remaining bowel 50% patients have recurrence within 5 years Antibiotics to treat infections Indications for surgery include hemorrhage, fistulas, abscesses or strictures. Surgery needed for about ¾ of patients. Usually total abdominal colectomy or total proctolectomy with ileostomy performed.

Surgery Total proctolectomy Total proctocolectomy with ileostomy

Surgery Total colectomy with ileorectal anastomosis

Prognosis No cure Higher risk for colon cancer Long periods of remission